Impacts of square stepping exercise on physical-cognitive function, biomarkers, body composition and mental health in healthy senior aged 60 and above: a systematic review

Abstract

Background: The aim of this systematic review is to analyze the effects of Square Stepping Exercise (SSE) on physical and cognitive function in older people, including its effects on biomarkers, body composition and mental health, focusing only on research that assessed the efficacy of SSE-based interventions. Methods: PubMed, Web of Science, Scopus and Cochrane databases were searched from June 2006 to June 2024 according to the PRISMA guidelines. The main search terms used were related to “older people” and “square-stepping exercise”. Controlled trials that included at least one intervention group focused on SSE were included. Participants had to be healthy, without physical or cognitive impairment, and the studies published in English or Spanish. The methodological quality of the selected research was assessed using the Physiotherapy Evidence Database (PEDro). Results: Twelve studies were selected from a total of 444 original records, with a total sample size of 577 participants. The health parameters of the participants were homogeneous, with ages ranging from 60 to 80 years. Significant gains were reported in certain physical function assessments, including balance, lower body strength and power, gait speed and flexibility. There were also significant findings in cognitive function, particularly in general cognitive status, focused attention, response time, basic task performance, and executive function. In addition, SSE can improve metrics such as body composition, brain-derived neurotrophic factor (BDNF), and mental health characteristics. Conclusions: SSE has the potential to significantly improve physical function, cognitive performance and body composition, as well as provide mental health benefits and have variable effects on biomarkers and cardiovascular health.